Arthroscopic Single-Portal Subscapularis Tendon Repair

Modified Single-Working Portal Technique Using Percutaneous Spinal Needle Suture Passing in Arthroscopic Subscapularis Repair

The main method for arthroscopic repair of the subscapularis is repair with suture anchors. The surgeon generally establishes the anterior and anterolateral operation portals to complete anchor implantation and suture passing, respectively. The single-operation portal technique has been developed recently. However, in the traditional single-operation portal technique, the suture device and grasper are difficult to operate simultaneously. In addition, with the traditional rotator cuff suture device, it is easy to cause further iatrogenic injury to the rotator cuff because of its larger diameter. Therefore, we describe a modified single-operation portal technique for suture passing percutaneously with a spinal needle taking into account the shortcomings of existing techniques. Our modified technique avoids the use of traditional suturing devices and effectively avoids further damage to the rotator cuff. The use of a single operation portal makes the operation more minimally invasive and simple and effectively avoids the problem of interference between the suture device and grasper in the same portal. The entire operational process does not require the use of costly consumables, resulting in increased cost-effectiveness and a significantly reduced operating time. In conclusion, our modified technique achieves the use of a single operation portal to suture the subscapularis through spinal needle suture passing, which has good clinical value.

Clinical efficacy and tendon integrity of patients with subscapularis tear by the technique of arthroscopic single external row repair

Background

With the development of arthroscopic technology and equipment, arthroscopy can effectively repair the tear of the subscapular muscle. However, it is difficult to expose the subscapular muscle and operate it under a microscope. In this study, the SwiveLock® C external row anchor under arthroscopy was applied to repair the tear of the subscapular muscle in a single row, which is relatively easy to operate with reliable suture and fixation, and its efficacy was evaluated.

Purpose

This study aimed to assess the clinical efficacy and the tendon integrity of patients who had subscapularis tears by adopting the single-row repair technique with a SwiveLock® C external row anchor.

Methods

Patients who had the subscapular muscle tear either with or without retraction were included, and their follow-up time was at least 1 year. The degree of tendon injury was examined by magnetic resonance imaging (MRI) and confirmed by arthroscopy. The tendon was repaired in an arthroscopic manner by utilizing the single-row technique at the medial margin of the lesser tuberosity. One double-loaded suture SwiveLock® C anchor was applied to achieve a strong fixation between the footprint and tendon. The range of motion, pain visual simulation score, American Shoulder and Elbow Surgeons (ASES) score, and Constant score of shoulder joint were evaluated for each patient before the operation, 3 months after the operation, and at least 1 year after the operation.

Results

In total, 110 patients, including 31 males and 79 females, with an average age of 68.28 ± 8.73 years were included. Arthroscopic repair of the subscapular tendon with SwiveLock® C external anchor can effectively improve the range of motion of the shoulder joint. At the last follow-up, the forward flexion of the shoulder joint increased from 88.97 ± 26.33° to 138.38 ± 26.48° (P < 0.05), the abduction range increased from 88.86 ± 25.27° to 137.78 ± 25.64° (P < 0.05), the external rotation range increased from 46.37 ± 14.48° to 66.49 ± 14.15° (P < 0.05), and the internal rotation range increased from 40.03 ± 9.01° to 57.55 ± 7.43° (P < 0.05). The clinical effect is obvious. The constant shoulder joint score increased from 40.14 ± 15.07 to 81.75 ± 11.00 (P < 0.05), the ASES score increased from 37.88 ± 13.24 to 82.01 ± 9.65 (P < 0.05), and the visual analog scale score decreased from 5.05 ± 2.11 to 1.01 ± 0.85 (P < 0.05). In the 6th month after the operation, two cases (1.81%) were confirmed to have re-tears via MRI.

Conclusion

In this study, we repaired the subscapularis muscle with a single-row technique fixed by SwiveLock® C anchor and FiberWire® sutures and evaluated its efficacy. The results showed that the clinical effect of single-row arthroscopic repair was satisfactory and that reliable tendon healing could be achieved.

Arthroscopic Subcoracoid Decompression, Coracoplasty, and Subscapularis Repair for Subscapularis Tears in the Setting of Subcoracoid Impingement

Subscapularis tears have been found to occur in the setting of subcoracoid impingement and are related to the narrowing of the coracohumeral interval. The advancement of arthroscopic techniques has allowed for improved identification and treatment of this historically overlooked pathology. Challenges of arthroscopic subscapularis treatment include nearby neurovascular structures, tendon retraction, and adhesions, which are further complicated by diminished arthroscopic visualization, resulting from the concomitant subcoracoid impingement. The purpose of this Technical Note is to describe our preferred technique for arthroscopic management of subscapularis tears in the setting of subcoracoid impingement that is simple and reproducible, as well as cost-effective and efficient with limited additional morbidity to that of a standard diagnostic shoulder arthroscopy.

Arthroscopic Subscapularis Repair Using 18-Gauge Spinal Needle as a Suture Passer to Eliminate Iatrogenic Tendon Damage from Modern Suturing Devices

Suture passing devices are frequently used for subscapularis tendon repair. However, some of these devices can further damage the tendon by creating a larger tear. Use of an 18-gauge spinal needle as a suture passer helps eliminate damage to the tendon. By using its smaller diameter, the needle prevents tendon cut-through and enhances the precision of the repair.

Single-Portal, Single-Anchor Repair of a Superior Third Subscapularis Tear Using a Self-Punching Knotless Soft Suture Anchor

Numerous techniques exist for arthroscopic subscapularis repair with varying degrees of complexity based on tear morphology, all of which have established satisfactory outcomes in function and patient satisfaction. Arthroscopic subscapularis repair can require several working portals and suture anchors, increasing both technical complexity and operative time. This Technical Note describes an arthroscopic repair of a superior one-third subscapularis tear using a self-punching knotless soft suture anchor through a single anterior working portal. Thus, we offer a unique approach to arthroscopic repair of superior one-third subscapularis tears that is time-saving, reproducible, and highly efficient while minimizing iatrogenic damage and postoperative complications.